^99Tc^m-3PRGD2整合素受体显像鉴别乳腺良恶性病变的价值及与超声检查的对比研究

The evaluation of 99Tcm-3PRGD2 integrin receptor imaging in the differential diagnosis in benign and malignant breast lesions comparision with ultrasound

目的 探讨99Tcm-3PRGD2整合素受体显像鉴别乳腺良恶性病变的价值及与超声检查的对比研究。方法 收集2016年10月至2017年6月因乳腺结节或肿块拟行穿刺或手术治疗的女性患者，行乳腺超声检查，选取超声提示病灶直径〉1 cm的45例患者经肘静脉注射99Tcm-3PRGD2（740-925 MBq）后行早期15 min SPECT静态显像及2 h SPECT/CT俯卧位显像。以病理结果为“金标准”，采用半定量分析指标T/NT值建立诊断阈值并进行诊断效能分析。组间比较采用独立样本非参数检验Mann-Whitney U方法；诊断效能比较采用χ2检验。结果 45例患者经病理学检查共发现56个病灶，其中，35个病灶为乳腺癌，21个病灶为良性病变。99Tcm-3PRGD2 2 h SPECT/CT显像的乳腺恶性病灶T/NT值（3.92±1.67）高于良性病灶T/NT值（2.04±0.46），且差异有统计学意义（Z=-3.77，P=0.00）。取约登指数最大时的临界值2.9，99Tcm-3PRGD2 SPECT/CT显像的灵敏度、特异度、准确率分别为82.9%、71.4%、78.6%，诊断乳腺良恶性病变受试者工作特征（ROC）曲线下面积为0.77；超声诊断乳腺良恶性病变ROC曲线下面积为0.76，其灵敏度、特异度、准确率分别为85.7%、66.7%、78.6%。99Tcm-3PRGD2 SPECT/CT与超声诊断效能相近（χ2=0.05，P〉0.05）。超声＋99Tcm-3PRGD2 SPECT/CT联合检查可提高乳腺良恶性诊断的准确率（92.9%），分别与二者比较差异均有统计学意义（χ2=77.17、74.87，均P〈0.05）。结论 99Tcm-3PRGD2整合素受体显像可以从肿瘤血管生成角度鉴别乳腺良恶性病变，提供解剖及功能信息，尤其对于超声声像图表现不典型时，可进一步鉴别良恶性，减少患者不必要的穿刺等有创性检查。

Objective To evaluate the diagnostic efficacy of 99Tcm-3PRGD2 integrin receptor imaging in the differential diagnosis of benign and malignant lesions in comparison with ultrasound. Methods Forty-five females（53.0±9.5 years old） with breast nodules or masses measuring over 1 cm from October 2016 to June 2017, which were diagnosed through ultrasound, underwent early imaging via 99Tcm-3PRGD2 （740-925 MBq） for 15 min and then SPECT/CT in prone position after 2 h. The pathology was the gold standard. Then, a semi-quantitative method was used to evaluate the values of 99Tcm-3PRGD2 integrin receptor imaging of breast lesions and compare them with ultrasound results. The Mann-Whitney U test was used to compare the groups. Lastly, diagnostic efficacy was compared using a chi-square test. Results 99Tcm-3PRGD2 integrin receptor imaging identified 56 lesions in 45 patients, 35 of which were malignant and 21 were benign. The T/NT values of the malignant lesions were significantly higher than those of the benign lesions（Z=-3.77, P=0.00） in the SPECT/CT images. The sensitivity, specificity, and accuracy of 99Tcm-3PRGD2 and ultrasound were 82.9%, 71.4%, and 78.6%, and 85.7%, 66.7%, and 78.6%, respectively. The critical value was 2.9 with the maximal Youden index. Furthermore, areas under the ROC curve for 99Tcm-3PRGD2 and ultrasound were 0.77 and 0.76, respectively. The diagnostic efficacy of 99Tcm-3PRGD2 was similar to that of ultrasonography（χ2=0.05, P〉0.05）. Thus, combining the two methods can improve the accuracy of diagnosis（92.9%） compare with ultrasound and 99Tcm-3PRGD2 （χ2=77.14, 74.87, all P〈0.05）. Conclusions 99Tcm-3PRGD2 integrin receptor imaging can identify benign and malignant breast lesions from an angiogenesis perspective with anatomical and functional information. Moreover, this technique can further identify benign and malignant lesions to reduce unnecessary punctures when ultrasonograms are unavailable.